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Maryland rates for HCPCS 21193

Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.08 / $1,246.43 / $1,392.30
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.22 / $1,538.54 / $1,953.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $507.00 / $641.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,155.29 / $1,683.88 / $2,806.94
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.76 / $1,637.99 / $2,149.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.00 / $847.00 / $1,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$994.74 / $1,389.72 / $2,860.94
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,176.70 / $1,460.22 / $1,817.26